Streamline Your NCQA Compliance! 🚀 Explore MHR's Tools & Templates and Lock in 2024 Pricing Today
About Us
About Susan Moore About MHR About Our Consultants MHR Executive & Admin Team Mission, Vision & Values MHR Newsletters MHR FAQS Careers Strategic Partners
Organizations
Organizations How We Work Case Studies Healthcare Equity
MHR Products
Tools and Templates Trainings MHR Tools, Templates and Training FAQ
Blog MHR Newsletters Events Contact

MHR Newsletter

Driving healthcare quality one NCQA accreditation at a time

2024 #8
August 15, 2024
By: Nancy Ross Bell

From Susan 

I was so pleased that 80 individuals from our client organizations attended our recent Triennial webinar. Please be sure to share the slides and recording with others within your organization who were unable to attend, as they include important, time-sensitive information. Several updates are highlighted in the Quality Insights section below. 

At this time of year, calendars start filling up with holiday travel plans and friends and family gatherings. To this end, we have listed important dates to place on your calendar for the remainder of 2024. 

  • August 31: Organizations planning to submit a CY 2026 Model of Care (MOC) to MHR for review should contact us by August 31 to schedule their consultation.
  • September 27: MHR’s Complimentary Webinar on NCQA Health Equity Accreditation - Common Challenges will be presented by MHR Consultant Sonia Frazier. To register, click this link:

Sept 27 - Complimentary Webinar - Health Equity

  • November 1: If you are attending NCQA’s Health Innovation Summit in Nashville, please plan to attend MHR’s client-only dinner. We would love to meet with you! Let us know by clicking on this link:

Nov 1 - Client Dinner - Nashville

  • December 13: MHR’s client-only training. Since this is after the release of the 2025 standards, it will surely be a lively discussion!

As you likely know, MHR is rolling out its new platform for templates, tools, and training (TTT). While our website is continuing to be developed, our TTTs are ready!  This month’s newsletter features our Population Health Management (PHM) Suite under MHR Products. 

Be sure to review the News articles we selected this month. There are several on coverage denials and prior authorization burden, plus more.

Lastly, as we await the release of the 2025 standards, you can go to NCQA’s Store and purchase them ahead of the release. We will be closely examining the updates and will bring these to your attention in our newsletters and blogs.  

Please let us know if you have any questions or comments by sending an email to 

[email protected]

MHR PRODUCTS:
POPULATION HEALTH MANAGEMENT SUITE

Having the right tools to implement a population health management (PHM) program led MHR to assemble its comprehensive PHM Suite to guide organizations pursuing NCQA Health Plan (HP) Accreditation and Population Health Program (PHP) Accreditation.

With over 120 pages of information and worksheets, users have what they need to fulfill the requirements for PHM 1, 2, 3, 4, and 6 and Population Health Program (PHP) 2 and 3.

Included in the PHM Suite are:

  • PHM Strategy Guide explains how to establish a PHM program and develop a PHM Strategy
  • PHM Strategies Catalog Template categorizes details of the PHM programs
  • PHM Strategy Template provides an outline to develop the PHM strategy with sub-populations in areas of focus
  • Population Health Assessment Guide explains the steps to developing a Population Assessment
  • Population Assessment Mind Map visualizes how PHM is integrated across the organization
  • Population Assessment Template provides a framework for annually assessing populations and sub-populations
  • Data Methodology and Collection Guides (three) explain data requirements and methodology and support trending of measures
  • PHM Strategy Effectiveness Analysis Template covers the steps to annually evaluate the effectiveness of the PHM program

Note:

Stand-alone tools, templates, and guides are available for purchase for PHM 5 (Complex Case Management).

Stand-alone tools, templates, and guides are available for PHM 7 (Delegation) and are also included in MHR’s Delegation Suite.

Features Facilitate Development

The PHM standards entail significant cross-functional and interdisciplinary collaboration. Due to their data-intensive requirements, the PHM-documented processes and reports can be challenging.

The PHM Suite includes features that MHR has added to its tools and templates so organizations can develop their documented processes and reports more efficiently and in a manner that is preferred by some NCQA surveyors. These include:   

  • Red text shows organizations where to fill in the blanks with your information, such as dates, program names, measures, and goals.
  • Green text provides examples of language so that you can draft your own where discussion or qualitative analysis is required.
  • Shaded text boxes provide instructions on what you must explain, such as introductions and methodology.
  • Tables and graphs are interspersed throughout to enter and display your information, such as methodology, goals, results, and activities.

Training Supplements Tools and Templates

Separate from the PHM Suite are training on the PHM standards and Quantitative and Qualitative (Q&Q) Analysis. Organizations new to PHM or with new or less experienced staff benefit from a deep dive into the standards and learning the steps needed for a compliant analysis.

Next Steps

  • Are you already an MHR client using some of the templates and wondering about the Suite? Having the entire PHM Suite will help you sustain your accreditation through the next cycle.
  • Wondering about updates to the tools and templates as standards change? No worries! When purchasing the PHM Suite, all updates through standards year 2028 are included in the purchase price.
  • Are you new to NCQA and unsure about your needs, or would like more information? If you are an MHR Client, please contact your MHR Consultant for assistance. All purchases are added to your invoice.
  •  Are you not an MHR client but would like more information or to purchase the PHM Suite or schedule our training? For assistance, please contact us at [email protected]

If you are not a current client, please reach out to Susan to schedule a Discovery Call and learn how we guide organizations on their path to NCQA Accreditation.  

 MHR CONSULTATION + TOOLS + TRAINING = NCQA SUCCESS

NEWS

You may not always have the time to scan the news, so we do it for you! Each month, we select articles that may be of interest to you for accreditation and healthcare quality.

Unforeseen Health Care Bills and Coverage Denials by Health Insurers in the U.S.

Improving Payment Integrity and Reducing Abrasion

Prior Authorization in Medicaid (Download publication)

Where Health Systems Are Going Wrong with Medicare Advantage

5 Factors Influencing Transformative Change in Healthcare

Cigna Distributes Grants to 22 Nonprofits Focused on Youth Mental Health

L.A. Care Prioritizes Patients by Addressing the Prior Authorization Burden and Improving Efficiency in the Health Care System

Marketplace Insurers Are Proposing A 7% Average Premium Hike For 2025 And Point To Rising Hospital Prices And GLP-1 Drugs As Key Drivers Of Costs

Silo Busting: 5 Ways to Improve Your Organization’s Customer Focus for Stars Rating Achievement

 QUALITY INSIGHTS

NCQA Surveyor Training

MHR Consultants, who are also NCQA Surveyors, attended NCQA’s latest Surveyor Training and summarized the latest information to those attending MHR’s August 9th Triennial webinar. We call out several updates below and refer you to the email with the recorded session and slides for more details. If you attended the session and did not receive the email, please let us know at [email protected]

  • Tuesday, October 29, 2024, is the date that Corrections and Policy Changes to the 2024 NCQA Health Plan Accreditation standards must be implemented! However, MHR recommends making the changes by Friday, October 25, to allow sufficient time to verify that the changes were implemented as planned.
  • NCQA has clarified that supporting evidence must be submitted either in the initial submission or during the preliminary issue response. Supporting evidence that was not included in the survey or provided in response to initial survey team issues cannot be submitted. The post-survey process is not an opportunity for organizations to submit evidence for the very first time.
  • Are you using Artificial Intelligence (AI) as part of your utilization management (UM) platform? NCQA has clarified in a PCS question that the “sole use of an AI platform to make UM approval decisions is not acceptable, as the standards require staff or licensed health professionals to make UM decisions...human involvement is necessary, even for approval decisions” (UM 4A.2).
  • The look-back periods for eight standards, some of which are related to health equity, were increased to 24 months.
  • NCQA has raised the bar on four Elements by increasing the number of factors you must meet in order to be scored as   These additional factors are subject to your look-back period. Some factors may necessitate process or system changes within your organization or with delegates. For example, Data Integration (PHM 2A) requires a minimum of 5 factors now instead of 3 to be scored as Met. The Case Management Process (PHM 5C) now requires a minimum of 14 Factors instead of 12 to be scored as Met.

Stay In Touch With News From NCQA:

  • The 2025 new standards are expected to be released “soon.” Go to the NCQA Store to purchase the standards that are effective for surveys with a start date of July 1, 2025, - June 30, 2026. As a reminder, before you purchase the E-Pub Standards and Guidelines, review your organization’s count for the Number of Users needed and NCQA’s Publication License Agreement.
  • Learn about NCQA’s new programs on behavioral health.

NCQA’s Certified Community Behavioral Health Clinics (CCBHC)

Behavioral Health Distinction for Patient-Centered Medical Homes (PCMH)

Be sure to read MHR’s latest blogs!

The need for long-term services and supports (LTSS) is on the rise. Our blog on Service Authorizations and Notifications calls out two new Elements for approving and denying LTSS and requirements for notifications.

Align Your Processes for LTSS Service Authorizations & Notifications with NCQA’s New Elements

UPCOMING INDUSTRY EVENTS

September 9-11, 2024
NAHQ Next 202

  • Virtual

September 24-26, 2024
AHIP: 2024 Consumer Experience and Digital Health Reform

  • Nashville, TN

September 27, 2024-Health Equity
MHR’s Complimentary Webinar

  • Live Webinar - Health Equity Accreditation Plus-Common Challenges
  • Register Now

 October 1-3, 2024
Rise: The 14th Annual HEDIS® & Quality Improvement Summit

  • Las Vegas, NV

October 31-November 2, 2024 - Save the Date- MHR Client Dinner on 11/1
NCQA Health Innovation Summit

  • Nashville, TN

December 13, 2024
MHR’s Client-Only Training – Save the Date

  • Live Webinar

CALENDAR OF OBSERVANCES

CALENDAR OF OBSERVANCES

While reviewing these observances, consider how you can integrate them into your organization’s population health management or quality improvement programs. 

  •  Are you servicing a population where suicide may be prevalent?
  •  Are childhood cancer or breast cancer areas where more community awareness would be helpful?
  •  What is the prevalence of COPD and Diabetes in your service areas? Does your data show opportunities for new programs or activities?
  •  Is your organization resolving to reach out to those who smoke and help guide them on a healthier path?

September

          National Suicide Prevention Month

          Childhood Cancer Awareness Month

October

          Breast Cancer Awareness Month

November

          COPD Awareness Month

          American Diabetes Month

December

          New Year’s Eve-Quit Smoking Resolutions

MHR was incorporated in 1991 and specializes in preparing organizations for all NCQA accreditation and certification products.

All MHR consultants were responsible for NCQA accreditation in their previous roles before joining MHR as an independent consultant. Most consultants are also NCQA surveyors and the majority are clinicians. Read more about How We Work!

We welcome hearing from you! Please get in touch with us. 

Follow MHR on LinkedIn and follow Susan on LinkedIn. 

Contact Us